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Kanashiro-Galo L, Alexandre AF, Tafuri WL, Barboza TC, Quaresma JAS, Brito ACD, Nascimento GYFDSD, Santos Filho AMD, Sotto MN, Pagliari C. Lacaziosis: immunohistochemical evaluation of elements of the humoral response in cutaneous lesions. Rev Inst Med Trop Sao Paulo 2020; 62:e75. [PMID: 33053144 PMCID: PMC7552988 DOI: 10.1590/s1678-9946202062075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/16/2020] [Indexed: 11/22/2022] Open
Abstract
Lacaziosis is a cutaneous mycosis caused by the fungus Lacazia loboi, described in different countries of Latin America and prevalent in the Amazon region. The ineffective immune response against the agent seems to be related to a Th2 pattern of cytokines. There are few reports exploring elements of the humoral response in these lesions. Our aim was to investigate some elements focusing on B cells, plasma cells and local expression of IgG and IgM antibodies. Forty skin biopsies of lower limbs were selected. The diagnosis of lacaziosis was based on direct mycological examination and histological analysis. The visualization of fungal cells was improved by using Gridley’s staining. An immunohistochemical protocol was performed to detect the expression of B cells, plasma cells, IgG and IgM. A double staining was performed to explore the presence of yeasts in the cytoplasm of keratinocytes, using an anti-AE1 AE3 antibody over Gridley’s staining. The inflammatory infiltrate consisted of macrophages, multinucleated giant cells, lymphocytes, and fibrosis. Fungal cells were frequent in the stratum corneum and in both, the dermis and, in 50% of the specimens, also in the epidermis. Cells expressing IgG were more abundant when compared to cells expressing IgM. B cells and the presence of IgG might indicate that the humoral response promotes a Th2 immune response resulting in an anti-inflammatory phenotype. Our results lead us to suggest a possible role of B cells and immunoglobulins in the mechanisms of lacaziosis pathogenesis.
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Affiliation(s)
- Luciane Kanashiro-Galo
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Patologia, São Paulo, São Paulo, Brazil
| | - Ariane Fernandes Alexandre
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Patologia, São Paulo, São Paulo, Brazil.,Instituto de Assistência Médica ao Servidor Público Estadual, Programa de Pós-Graduação em Ciências da Saúde, São Paulo, São Paulo, Brazil
| | - Wagner Luiz Tafuri
- Universidade Federal de Minas Gerais, Instituto de Ciências Biológicas, Departamento de Patologia Geral, Belo Horizonte, Minas Gerais, Brazil
| | - Tânia Cristina Barboza
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Patologia, São Paulo, São Paulo, Brazil.,Instituto de Assistência Médica ao Servidor Público Estadual, Programa de Pós-Graduação em Ciências da Saúde, São Paulo, São Paulo, Brazil
| | - Juarez Antonio Simões Quaresma
- Universidade Federal do Pará, Núcleo de Medicina Tropical, Belém, Pará, Brazil.,Universidade do Estado do Pará, Centro de Ciências Biológicas e da Saúde, Belém, Pará, Brazil
| | | | - Gabriela Yasmin Francisca da Silva do Nascimento
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Patologia, São Paulo, São Paulo, Brazil.,Instituto de Assistência Médica ao Servidor Público Estadual, Programa de Pós-Graduação em Ciências da Saúde, São Paulo, São Paulo, Brazil
| | - Antonio Marques Dos Santos Filho
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Clínica Dermatológica, São Paulo, São Paulo, Brazil
| | - Mirian Nacagami Sotto
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Patologia, São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Dermatologia Tropical, São Paulo, São Paulo, Brazil
| | - Carla Pagliari
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Patologia, São Paulo, São Paulo, Brazil.,Instituto de Assistência Médica ao Servidor Público Estadual, Programa de Pós-Graduação em Ciências da Saúde, São Paulo, São Paulo, Brazil
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Alexandre AF, Quaresma JAS, Barboza TC, de Brito AC, Xavier MB, de Oliveira CMM, Unger DAA, Kanashiro-Galo L, Sotto MN, Duarte MIS, Pagliari C. The cytotoxic T cells may contribute to the in situ immune response in Jorge Lobo's Disease human lesions. Med Mycol 2017; 55:145-149. [PMID: 27562863 DOI: 10.1093/mmy/myw059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 04/13/2016] [Accepted: 06/10/2016] [Indexed: 11/14/2022] Open
Abstract
Jorge Lobo's Disease (JLD) is a cutaneous chronic granulomatous disease caused by the pathogenic fungus Lacazia loboi. It is characterized by a granulomatous reaction with multinucleated giant cells and high number of fungal cells. In order to contribute to the comprehension of immune mechanisms in JLD human lesions, we studied the cytotoxic immune response, focusing on TCD8+ and NK cells, and granzyme B. Forty skin biopsies of lower limbs were selected and an immunohistochemistry protocol was developed to detect CD8+ T cells, NK cells and Granzyme B. In order to compare the cellular populations, we also performed a protocol to visualize TCD4+ cells. Immunolabeled cells were quantified in nine randomized fields in the dermis. Lesions were characterized by inflammatory infiltrate of macrophages, lymphocytes, epithelioid and multinucleated giant cells with intense number of fungal forms. There was a prevalence of CD8 over CD4 cells, followed by NK cells. Our results suggest that in JLD the cytotoxic immune response could represent another important mechanism to control Lacazia loboi infection. We may suggest that, although CD4+ T cells are essential for host defense in JLD, CD8+ T cells could play a role in the elimination of the fungus.
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Affiliation(s)
- Ariane Fernandes Alexandre
- Faculdade de Medicina, Universidade de São Paulo, Departamento de Patologia.,Programa de Pós-graduação em Ciências da Saúde/Instituto de Assistência Médica ao Servidor Público Estadual
| | | | - Tânia Cristina Barboza
- Faculdade de Medicina, Universidade de São Paulo, Departamento de Patologia.,Programa de Pós-graduação em Ciências da Saúde/Instituto de Assistência Médica ao Servidor Público Estadual
| | | | | | | | | | | | | | | | - Carla Pagliari
- Faculdade de Medicina, Universidade de São Paulo, Departamento de Patologia .,Programa de Pós-graduação em Ciências da Saúde/Instituto de Assistência Médica ao Servidor Público Estadual
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Kanashiro-Galo L, Pagliari C, Barboza TC, de Brito AC, Xavier MB, de Oliveira CMM, Unger DAA, Sotto MN, Quaresma JAS, Duarte MIS. Th17 and regulatory T cells contribute to the in situ immune response in skin lesions of Jorge Lobo's disease. Med Mycol 2015; 54:23-8. [PMID: 26333354 DOI: 10.1093/mmy/myv069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 06/30/2015] [Indexed: 12/23/2022] Open
Abstract
Jorge Lobo's disease (JLD) is a chronic granulomatous mycosis described in various Latin American countries. The main objective of the present study was to investigate the possible role of Th17 and Foxp3+ Treg cells in the pathogenesis of Jorge Lobo's disease. Human skin biopsies were submitted to an immunohistochemistry protocol to detect Foxp3, interleukin (IL)-1beta, CD25, IL-6, IL-17, and IL-23. The epidermis presented acanthosis, hyperkeratosis, and frequent presence of fungi. The dermis presented inflammatory infiltrate comprising macrophages, lymphocytes, epithelioid and multinucleated cells, and an intense number of fungi. Foxp3+ Treg cells and IL-17+ cells were visualized in lymphocytes in the inflammatory infiltrate. IL-1, IL-2R (CD25), IL-6, and IL-23 were visualized in the dermis, intermingled with fungal cells, permeating or participating of the granuloma. Following IL-17, the most prominent cytokine was IL-6. IL-23 and cells expressing CD25 were present in fewer number. The comparative analysis between IL-17 and Foxp3 demonstrated a statistically significant increased number of IL-17+ cells. Th17 cells play a role in the immune response of JLD. IL-1beta and IL-6 added to the previously described increased number of TGF-beta would stimulate such pattern of response. Th17 cells could be present as an effort to modulate the local immune response; however, high levels of a Th17 profile could overcome the role of Treg cells. The unbalance between Treg/Th17 cells seems to corroborate with the less effective immune response against the fungus.
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Affiliation(s)
- Luciane Kanashiro-Galo
- Universidade de São Paulo, Faculdade de Medicina, Laboratório da Disciplina de Patologia de Moléstias Transmissíveis, São Paulo, SP, Brasil
| | - Carla Pagliari
- Universidade de São Paulo, Faculdade de Medicina, Laboratório da Disciplina de Patologia de Moléstias Transmissíveis, São Paulo, SP, Brasil Instituto de Assistência Médica ao Servidor Público Estadual, Programa de pós-graduação em Ciências da Saúde, São Paulo, SP, Brasil
| | - Tania Cristina Barboza
- Universidade de São Paulo, Faculdade de Medicina, Laboratório da Disciplina de Patologia de Moléstias Transmissíveis, São Paulo, SP, Brasil Instituto de Assistência Médica ao Servidor Público Estadual, Programa de pós-graduação em Ciências da Saúde, São Paulo, SP, Brasil
| | | | - Marilia Brasil Xavier
- Nucleo de Medicina Tropical, Universidade Federal do Pará, Belém, PA, Brasil Universidade do Estado do Pará, PA, Brasil
| | | | | | - Mirian Nacagami Sotto
- Universidade de São Paulo, Faculdade de Medicina, Laboratório da Disciplina de Patologia de Moléstias Transmissíveis, São Paulo, SP, Brasil
| | | | - Maria Irma Seixas Duarte
- Universidade de São Paulo, Faculdade de Medicina, Laboratório da Disciplina de Patologia de Moléstias Transmissíveis, São Paulo, SP, Brasil
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Barboza TC, Quaresma JAS, de Brito AC, Xavier MB, de Oliveira CMM, Unger DAA, Duarte MIS, Sotto MN, Pagliari C. Jorge Lobo's disease: immunohistochemical characterization of dendritic cells in cutaneous lesions. Mycopathologia 2014; 179:269-74. [PMID: 25487975 DOI: 10.1007/s11046-014-9836-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 11/13/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Jorge Lobo's disease (JLD) is a cutaneous chronic mycosis caused by Lacazia loboi. We studied Factor XIIIa + dermal dendrocytes (FXIIIa + DD), Langerhans cells (LC) through the expression of langerin and the expression of S100 protein. METHODS A total of 41 biopsies and 10 normal skins (control) were developed with a polymer-based immunohistochemical method. RESULTS Lesions presented infiltrate comprising macrophages, some asteroid corpuscles, lymphocytes, multinucleated giant cells and a large number of fungi. LCs presented short dendrites and were scarcely distributed. Dermal langerin + cells were detected in nine JLD lesions. FXIIIa + DD were hypertrophic, visualized in the inflammatory infiltrate of JLD lesions. Cells S100+ were present in JLD and control group with a similar number of cells. A total of 14 specimens did not express FXIIIa, and this considerable number probably contributed to the statistical similarity with the control group. CONCLUSIONS The results indicate that LCs are present in the immune response against Lacazia loboi. Some dermal langerin + cells could be another subset of dendritic cells. Our data indicate changes of LCs in JLD cutaneous lesions and present, for the first time, results that show langerin + cells in the dermis and corroborate previous observations on the participation of FXIIIa + DD in the in situ immune response in JLD.
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Affiliation(s)
- Tania Cristina Barboza
- Instituto de Assistência Médica ao Servidor Público Estadual, Programa de pós-graduação em Ciências da Saúde, São Paulo, SP, Brazil
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Quaresma JAS, Brito MV, Sousa JR, Silva LM, Hirai KE, Araujo RS, de Brito AC, Carneiro FRO, Fuzii HT, Pagliari C, Sotto MN, Duarte MIS. Analysis of microvasculature phenotype and endothelial activation markers in skin lesions of lacaziosis (Lobomycosis). Microb Pathog 2014; 78:29-36. [PMID: 25450888 DOI: 10.1016/j.micpath.2014.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 11/18/2014] [Accepted: 11/20/2014] [Indexed: 10/24/2022]
Abstract
Jorge Lobo's disease is a rare mycosis characterized by chronic inflammation, which causes skin lesions in the absence of visceral dissemination. The disease occurs mainly in hot and humid climates and most cases have been registered in the Brazilian Amazon region. This study investigated possible microvascular alterations in skin lesions caused by infection with Lacazia loboi which may interfere with the clinical progression of the disease. Immunohistochemistry was used to evaluate the density of blood and lymphatic vessels, as well as expression of the cell adhesion molecules ICAM-1, VCAM-1 and E-selectin. The results showed a reduced number of blood (62.66 ± 20.30 vessels/mm(2)) and lymphatic vessels (3.55 ± 5.84 vessels/mm(2)) in Jorge Lobo's disease when compared to control skin (169.66 ± 66.38 blood vessels/mm(2) and 8 ± 2.17 lymphatic vessels/mm(2)). There were a larger number of vessels expressing ICAM-1 (27.58 ± 15.32 vessels/mm(2)) and VCAM-1 (7.55 ± 6.2 vessels/mm(2)). No difference was observed in the expression of E-selectin (4.66 ± 11 vessels/mm(2)). Taken together, the results indicate changes in the local microvasculature which may interfere with the development of an efficient cell-mediated immune response and may explain restriction of the fungus to the site of injury.
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Affiliation(s)
- Juarez A S Quaresma
- Nucleo de Medicina Tropical, Universidade Federal do Para, Belem, PA, Brazil; Centro de Ciencias Biologicas e da Saude, Universidade do Estado do Para, Belem, PA, Brazil.
| | - Maysa V Brito
- Nucleo de Medicina Tropical, Universidade Federal do Para, Belem, PA, Brazil
| | - Jorge R Sousa
- Nucleo de Medicina Tropical, Universidade Federal do Para, Belem, PA, Brazil
| | - Luciana M Silva
- Centro de Ciencias Biologicas e da Saude, Universidade do Estado do Para, Belem, PA, Brazil
| | - Kelly E Hirai
- Centro de Ciencias Biologicas e da Saude, Universidade do Estado do Para, Belem, PA, Brazil
| | - Rafael S Araujo
- Centro de Ciencias Biologicas e da Saude, Universidade do Estado do Para, Belem, PA, Brazil
| | - Arival C de Brito
- Nucleo de Medicina Tropical, Universidade Federal do Para, Belem, PA, Brazil
| | - Francisca R O Carneiro
- Centro de Ciencias Biologicas e da Saude, Universidade do Estado do Para, Belem, PA, Brazil
| | - Hellen T Fuzii
- Nucleo de Medicina Tropical, Universidade Federal do Para, Belem, PA, Brazil
| | - Carla Pagliari
- Departamento de Patologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Mirian N Sotto
- Departamento de Patologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Maria I S Duarte
- Departamento de Patologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Relationship between growth factors and its implication in the pathogenesis of leprosy. Microb Pathog 2014; 77:66-72. [PMID: 25457797 DOI: 10.1016/j.micpath.2014.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 10/07/2014] [Accepted: 10/15/2014] [Indexed: 11/23/2022]
Abstract
Leprosy is a chronic infectious disease caused by Mycobacterium leprae which affects the skin and peripheral nervous system. The immune response of the host determines the clinical course of the disease. The tuberculoid form is the result of high cell-mediated immunity characterized by a Th1 response, whereas the lepromatous form is characterized by low cell-mediated immunity and a Th2 humoral response. The neural damage established produces marked changes in the expression of growth factors such as nerve growth factor (NGF) and its receptors (NGF-R). The expression of NGF, associated with the expression of Th1 and Th2 cytokines, might be involved in the tissue damage caused by the bacillus. Therefore, the objective of this study was to correlate the immunoexpression patterns of NGF and NGF-R in the different clinical forms of leprosy, and to associate the findings with the in situ expression of TGF-β and clinical classification of the disease. TGF-β, NGF and NGF-R immunoexpression was analyzed by immunohistochemistry in paraffin-embedded material. Most patients were males with a mean age of 40.7 years. TGF-β levels were significantly higher in the lepromatous forms. No significant difference in the immunoexpression of NGF or NGF-R was observed between the clinical forms, but expression tended to be higher at the lepromatous pole. There was a significant positive correlation between NGF and NGF-R in the different clinical forms of leprosy. A significant positive correlation was observed between NGF, NGF-R and TGF-β. It can be concluded that, even existing evidence on the role of these molecules in the clinical spectrum of leprosy.
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Francesconi VA, Klein AP, Santos APBG, Ramasawmy R, Francesconi F. Lobomycosis: epidemiology, clinical presentation, and management options. Ther Clin Risk Manag 2014; 10:851-60. [PMID: 25328400 PMCID: PMC4199563 DOI: 10.2147/tcrm.s46251] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Lobomycosis is a subcutaneous mycosis of chronic evolution caused by the Lacazia loboi fungus. Its distribution is almost exclusive in the Americas, and it has a particularly high prevalence in the Amazon basin. Cases of lobomycosis have been reported only in dolphins and humans. Its prevalence is higher among men who are active in the forest, such as rubber tappers, bushmen, miners, and Indian men. It is recognized that the traumatic implantation of the fungus on the skin is the route by which humans acquire this infection. The lesions affect mainly exposed areas such as the auricles and upper and lower limbs and are typically presented as keloid-like lesions. Currently, surgical removal is the therapeutic procedure of choice in initial cases. Despite the existing data and studies to date, the active immune mechanisms in this infection and its involvement in the control or development of lacaziosis have not been fully clarified. In recent years, little progress has been made in the appraisal of the epidemiologic aspects of the disease. So far, we have neither a population-based study nor any evaluation directed to the forest workers.
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Affiliation(s)
| | | | | | - Rajendranath Ramasawmy
- Department of Immunogenetics, Tropical Medicine Foundation Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Fábio Francesconi
- Department of Dermatology, Tropical Medicine Foundation Heitor Vieira Dourado, Manaus, Amazonas, Brazil
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Pagliari C, Kanashiro-Galo L, Silva AADL, Barboza TC, Criado PR, Duarte MIS, Brito ACD, Xavier MB, Unger D, Maria Moraes Oliveira C, Quaresma JAS, Sotto MN. Plasmacytoid dendritic cells in cutaneous lesions of patients with chromoblastomycosis, lacaziosis, and paracoccidioidomycosis: a comparative analysis. Med Mycol 2014; 52:397-402. [PMID: 24782102 DOI: 10.1093/mmy/myt026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Plasmacytoid dendritic cells (pDCs) are characterized by expression of CD123 and BDCA-2 (Blood Dendritic Cell Antigen 2) (CD303) molecules, which are important in innate and adaptive immunity. Chromoblastomycosis (CBM), lacaziosis or Jorge Lobo's disease (JLD), and paracoccidioidomycosis (PCM), are noteworthy in Latin America due to the large number of reported cases. The severity of lesions is mainly determined by the host's immune status and in situ responses. The dendritic cells studied in these fungal diseases are of myeloid origin, such as Langerhans cells and dermal dendrocytes; to our knowledge, there are no data for pDCs. Forty-three biopsies from patients with CBM, 42 from those with JLD and 46 diagnosed with PCM, were evaluated by immunohistochemistry. Plasmacytoid cells immunostained with anti-CD123 and anti-CD303 were detected in 16 cases of CBM; in those stained with anti-CD123, 24 specimens were obtained from PCM. We did not detect the presence of pDCs in any specimen using either antibody in JLD. We believe that, albeit a secondary immune response in PCM and CBM, pDCs could act as a secondary source of important cytokines. The BDCA-2 (CD303) is a c-type lectin receptor involved in cell adhesion, capture, and processing of antigens. Through the expression of the c-lectin receptor, there could be an interaction with fungi, similar to other receptors of this type, namely, CD207 in PCM and CD205 and CD209 in other fungal infections. In JLD, the absence of expression of CD123 and CD303 seems to indicate that pDCs are not involved in the immune response.
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Affiliation(s)
- Carla Pagliari
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Patologia
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Papadavid E, Dalamaga M, Kapniari I, Pantelidaki E, Papageorgiou S, Pappa V, Tsirigotis P, Dervenoulas I, Stavrianeas N, Rigopoulos D. Lobomycosis: A case from Southeastern Europe and review of the literature. J Dermatol Case Rep 2012; 6:65-9. [PMID: 23091581 DOI: 10.3315/jdcr.2012.1104] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 07/19/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND Lobomycosis, also known as Jorge Lobo's disease, represents a rare chronic subcutaneous mycosis caused by the fungus Lacazia loboi, an organism that is found within lesions but has not been cultured to date. The natural reservoir of L. loboi is unknown but it is believed to be aquatic, or associated with soil and vegetation. More than 550 human cases have been reported, especially in patients with a history of travel or residence in endemic areas (Central and South America, particularly Brazil) or in communities along rivers. MAIN OBSERVATIONS We describe a 64-year-old Greek female farmer living in a coastal region, who presented with an erythematous plaque on her left inner thigh resembling a keloid. The diagnosis was based on the triad: 1) absence of fungal growth in cultures, 2) positive direct microscopic examination of the lesion and 3) histopathology, all consistent with lobomycosis. Particularly, skin biopsy showed deep cutaneous fungal infection with granulomatous reaction. Fungal cells were found inside giant cells. The fungi were thick-walled with some budding, isolated or in short chains. Dermal fibrosis was present. Our patient had a medical history of common variable immunodeficiency but no history of travel to South or Central America. She probably acquired this rare infection by injury during her agricultural works. CONCLUSION Our case represents probably the first documented case of human lobomycosis in Southeastern Europe. This case is unusual due to the rarity of lobomycosis in Mediterranean countries, particularly in Southeastern Europe.
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Affiliation(s)
- Evangelia Papadavid
- 2nd Department of Dermatology, Athens University School of Medicine, Attikon General University Hospital, Chaidari, Athens, Greece
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Paniz-Mondolfi A, Talhari C, Sander Hoffmann L, Connor DL, Talhari S, Bermudez-Villapol L, Hernandez-Perez M, Van Bressem MF. Lobomycosis: an emerging disease in humans and delphinidae. Mycoses 2012; 55:298-309. [DOI: 10.1111/j.1439-0507.2012.02184.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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